Citation Nr: 9919654
Decision Date: 07/19/99 Archive Date: 07/28/99
DOCKET NO. 97-17 703 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Columbia,
South Carolina
THE ISSUE
Entitlement to an increased rating for schizo-affective
disorder with bipolar disorder, currently evaluated as 50
percent disabling.
REPRESENTATION
Appellant represented by: The American Legion
WITNESSES AT HEARING ON APPEAL
Appellant and his wife
ATTORNEY FOR THE BOARD
Todd R. Vollmers, Associate Counsel
INTRODUCTION
The veteran had active service from July 1972 to November
1973 and December 1974 to February 1976.
This case came before the Board of Veterans' Appeals (Board)
on appeal from a decision of the Department of Veterans
Affairs (VA) Regional Office (RO) in Columbia, South
Carolina, in June 1996 that denied an increased evaluation
for schizo-affective disorder with bipolar disorder,
currently evaluated as 50 percent disabling.
FINDING OF FACT
The veteran's schizo-affective disorder with bipolar disorder
is productive of severe, but not total, social and industrial
inadaptability.
CONCLUSION OF LAW
Schizo-affective disorder with bipolar disorder is 70 percent
disabling and no more according to the schedular criteria.
38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2,
4.3, 4.10, and Part 4 Code 9205 (1996) and Code 9211 (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Factual Background
The veteran's service medical records show that no
psychiatric problems were noted during a physical examination
in July 1974. A report of medical examination dated in
October 1973 was also negative for any psychiatric problems.
Another report of medical examination dated in January 1976
listed the veteran's psychiatric evaluation as normal. A
letter dated in January 1976 noted a diagnosis of adjustment
reaction of early adult life manifested by anxiety,
irritability and frustration, secondary to being in the
military.
After service, the veteran was admitted to a private hospital
in August 1976 with a diagnosis of schizophrenia, chronic
undifferentiated type. The veteran was again treated for
schizophrenia in October 1976. Other private medical records
show that the veteran continued to have hallucinations,
delusions, and mild depression in March 1978.
A VA examination in May 1978 found that the veteran had
schizophrenia, paranoid type. Thereafter, the veteran was
hospitalized for his psychiatric problems at VA facilities
from September to October 1979, December 1979 to January
1980, and February 1981 to March 1981.
A VA examination in January 1982 gave a diagnosis of
schizophrenic reaction, paranoid type, which was assessed as
mild to moderately disabling.
The veteran continued to receive VA treatment for psychiatric
problems from December 1981 to March 1982. The veteran was
again hospitalized for atypical psychosis from September to
October 1982, and continued to receive VA treatment in
November 1982.
A VA examination in November 1983 found that the veteran
continued to have paranoid schizophrenia, with depressed
mood.
VA records show that the veteran was again hospitalized for
paranoid schizophrenia from October to November 1984, and in
April 1985. Other VA records show hospitalization for
paranoid schizophrenia from April to May 1986, and from June
to July 1986.
A VA examination in August 1986 gave a diagnosis of
schizophrenic disorder, assessed as moderate to severe.
The veteran was hospitalized at a VA facility from September
to October 1986. The veteran was again hospitalized from
October 1986 to January 1987, and continued to receive VA
treatment from February 1987 to March 1989, with periods of
hospitalization in September 1987 and September 1988.
Other VA records show hospitalization from March 1989 to
April 1989, and treatment in June 1989. The veteran was
again hospitalized in July 1989.
VA records show that the veteran received treatment in
January and February 1994, and was hospitalized in March 1994
with suicidal ideation. His affect was inappropriate, his
mood was depressed, he was preoccupied and admitted to
hearing voices. With treatment his condition improved and he
was discharged. The veteran was also apparently served with
commitment papers to a private hospital in April 1994, due to
a lack of beds at the VA facility. Other VA records show
continuing treatment from May 1994 through November 1995.
The veteran filed a claim for an increased rating for his
service connected psychiatric disability in November 1995.
On VA examination in December 1995, the veteran reported
suicidal and homicidal ideation. He also reported hearing
voices. He was currently employed, reporting it was his 17th
job in five years, but indicated that he had held this job
since May 1994. On mental status examination, he was
described as alert, oriented and cooperative, but somewhat
boisterous. Mood was mildly euphoric. Thought processes
were somewhat rapid with some tangentiality and loosening of
associations. Thought content included auditory
hallucinations and some paranoid ideation. The diagnosis was
schizoaffective disorder, hypomanic. The examiner commented
that given the severity of symptoms, it was remarkable that
the veteran could maintain a job. The level of the veteran's
disability was estimated as being in the high/ moderate to
severe range.
The veteran received VA treatment from January through April
1996, and was hospitalized in May 1996 following a suicide
attempt. During the course of hospitalization, it was noted
that he was manic. With medication, his condition improved
and he was neither manic nor suicidal at the time of
discharge. He was considered able to go back to work. Other
records show treatment in June 1996.
The veteran was again hospitalized at a VA facility in March
and April 1997 with suicidal and homicidal thoughts.
Treatment was instituted and at the time of discharge from
the hospital, he was not suicidal or homicidal, was not
experiencing hallucinations, and was not a danger to himself
or others. He was to return to work at his discretion.
At a hearing at the RO in September 1997, the veteran and his
wife testified that his disability had become worse, and that
he became angry very easily and had thoughts of homicide and
suicide. The veteran also testified that he had trouble
keeping jobs due to his anger, and heard voices.
VA treatment records dated in September 1997 show that the
veteran was observed to be very angry at times, and that he
had trouble finding jobs. The veteran was assessed as having
considerable to severe social and industrial impairment.
A VA examination record dated in April 1998 noted the
veteran's report that he had had 28 jobs over the prior four
to five years, and that the veteran was last hospitalized in
October 1997. The veteran also reported being suspicious and
hearing voices several times per week. The veteran stated
that he stayed at home when he was not at work, and got along
reasonably well with his wife although they were attending
counseling sessions. On mental status examination, it was
noted that he was oriented, but his affect seemed to be
somewhat elevated. He was quite talkative and his thoughts
were logical. He denied auditory hallucinations presently,
but had them as recently as the past week. He appeared to be
somewhat inappropriate. The axis I impression was
schizoaffective disorder. The veteran's GAF [global
assessment of functioning] score was 55. The examiner also
noted the veteran's history of frequent disruptive episodes
that were both affective and psychotic, and that the veteran
had had "a great deal of occupational disruption and social
disruption due to his episodes of exacerbation of his
symptoms." The examiner stated his assessment that the
veteran was moderately to severely disabled from his
psychiatric disorder.
Analysis
In evaluating the severity of a particular disability, it is
essential to consider its history. Schafrath v. Derwinski, 1
Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2. Disability
evaluations, in general, are intended to compensate for the
average impairment of earning capacity resulting from a
service-connected disability. They are primarily determined
by comparing objective clinical findings with the criteria
set forth in the rating schedule. 38 U.S.C.A. § 1155 (West
1991 & Supp. 1998); 38 C.F.R. Part 4 (1998).
In cases where regulations concerning entitlement to a higher
rating are changed during the course of a pending claim, the
veteran is entitled to a decision on his claim under the
criteria which are most favorable to him. Karnas v.
Derwinski, 1 Vet. App. 308 (1991).
The Board notes that the veteran's claim relating to his
psychiatric disorder was filed prior to November 7, 1996,
when the rating criteria for mental disorders were revised.
Therefore, under Karnas v. Derwinski, the veteran is entitled
to consideration under the criteria in effect both before,
and after November 1996, and a decision which reflects the
criteria most favorable to him.
Rating criteria in effect prior to November 7, 1996
Under the general rating formula for psychotic disorders in
effect prior to November 1996, active psychotic
manifestations of such extent, severity, depth, persistence
or bizarreness as to produce total social and industrial
inadaptability warrant a 100 percent rating. With lesser
symptomatology such as to produce severe impairment of
social and industrial adaptability, a 70 percent rating is
proper. For considerable impairment of social and industrial
adaptability, a 50 percent rating will be granted. Definite
impairment of social and industrial adaptability warrants a
30 percent rating, mild impairment of social and industrial
adaptability gives a 10 percent rating, and a noncompensable
evaluation is given for psychosis in full remission. 38
C.F.R. § 4.132, Code 9205 (1996).
The record shows that the veteran has received extensive
treatment for his psychiatric disability in recent years, and
has been hospitalized several times. The most recent medical
evidence regarding the veteran's disability, a VA examination
report dated in April 1998, shows that the veteran has had
trouble remaining employed due to his hearing voices and
being suspicious of other people. The veteran also had
trouble maintaining relationships with other people, and
stayed at home when not working. The examiner stated his
opinion that the veteran's disability caused a great deal of
occupational and social disruption, and found the veteran to
be severely disabled. He has, however, been able to maintain
employment. The evidence does not indicate that the
veteran's disability meets the criteria for a 100 percent
rating, with active psychotic manifestations of such extent,
severity, depth, persistence or bizarreness that would
produce total social and industrial inadaptability; however,
the record does reflect symptoms consistent with severe
social and industrial inadaptability. Therefore, a 70
percent evaluation for the veteran's schizo-affective
disorder with bipolar disorder is warranted under the
criteria in effect prior to November 7, 1996.
Rating criteria in effect after November 7, 1996
In November 1996, the general rating formula for mental
disorders was revised. The following criteria were adopted:
For total occupational and social impairment, due to such
symptoms as: gross impairment in thought processes or
communication; persistent delusions or hallucinations;
grossly inappropriate behavior; persistent danger of hurting
self or others; intermittent inability to perform activities
of daily living (including maintenance of minimal personal
hygiene); disorientation to time or place; memory loss for
names of close relatives, own occupation, or own name, a 100
percent rating is appropriate. When there is occupational
and social impairment with deficiencies in most areas, such
as work, school, family relations, judgment, thinking, or
mood, due to such symptoms as: suicidal ideation;
obsessional rituals which interfere with routine activities;
speech intermittently illogical, obscure, or irrelevant;
near-continuous panic or depression affecting the ability to
function independently, appropriately and effectively;
impaired impulse control (such as unprovoked irritability
with periods of violence); spatial disorientation; neglect of
personal appearance and hygiene; difficulty in adapting to
stressful circumstances (including work or a worklike
setting); inability to establish and maintain effective
relationships, a 70 percent evaluation is warranted.
Occupational and social impairment with reduced reliability
and productivity due to such symptoms as: flattened affect;
circumstantial, circumlocutory, or stereotyped speech; panic
attacks more than once a week; difficulty in understanding
complex commands; impairment of short- and long-term memory
(e.g., retention of only highly learned material, forgetting
to complete tasks); impaired judgment; impaired abstract
thinking; disturbances of motivation and mood; difficulty in
establishing and maintaining effective work and social
relationships, a 50 percent rating is proper. With
occupational and social impairment with occasional decrease
in work efficiency and intermittent periods of inability to
perform occupational tasks (although generally functioning
satisfactorily, with routine behavior, self-care, and
conversation normal), due to such symptoms as: depressed
mood, anxiety, suspiciousness, panic attacks (weekly or less
often), chronic sleep impairment, mild memory loss (such as
forgetting names, directions, recent events), a 30 percent
evaluation is indicated. For occupational and social
impairment due to mild or transient symptoms which decrease
work efficiency and ability to perform occupational tasks
only during periods of significant stress, or; symptoms
controlled by continuous medication, a 10 percent rating is
appropriate. If a mental condition has been formally
diagnosed, but symptoms are not severe enough either to
interfere with occupational and social functioning or to
require continuous medication, a noncompensable evaluation is
to be assigned. 38 C.F.R. § 4.130, Code 9211 (1998).
When evaluating a mental disorder, the rating agency shall
consider the frequency, severity, and duration of psychiatric
symptoms, the length of remissions, and the veteran's
capacity for adjustment during periods of remission. The
rating agency shall assign an evaluation based on all the
evidence of record that bears on occupational and social
impairment rather than solely on the examiner's assessment of
the level of disability at the moment of the examination. 38
C.F.R. § 4.126 (1998).
The record is again reflective of findings consistent with a
70 percent evaluation. He has had longstanding treatment for
depression and anger, with some suicidal ideation. The April
1998 VA examination report found that the veteran had had a
great deal of occupational and social disruption due to
exacerbations of his symptoms, and that the veteran was
moderately to severely disabled due to his psychiatric
disorder. Considering the veteran's current symptoms, as
well as 38 C.F.R. § 4.126 and the evidence of continuing
treatment and hospitalization for the veteran's psychiatric
disorder, along with the ability for adjustment during
periods of remission, a 70 percent rating is warranted under
the criteria in effect after November 7, 1996. Although the
record shows some auditory hallucinations and suicidal
ideation, there is no indication that the veteran is unable
to perform activities of daily living, such as personal
hygiene, or that he is disoriented to time or place, suffers
memory loss, or otherwise suffers total occupational and
social impairment. A rating of 100 percent is therefore not
warranted at this time.
ORDER
Entitlement to an increased rating of 70 percent, and no
more, for schizo-affective disorder with bipolar disorder is
granted.
C. W. Symanski
Member, Board of Veterans' Appeals